Do healthcare strategies have to be long-term?

If you read nothing else, read this:

• Short-term initiatives can help to lay the foundations for a long-term change in employee health and wellbeing.
• Behaviours, such as healthy eating or exercise, must be repeated regularly if they are to become a habit.
• Regular communication about healthy initiatives at work can help to create a healthy culture.

But can initiatives that are short-term, or focused on a one-off event, have a long-lasting effect on health and wellbeing?

Organisations first need to assess their objectives in offering benefits that promote healthy lifestyles, and from there determine how to make the programme sustainable. Rebekah Haymes, senior consultant at Towers Watson, says there can be many reasons why an employer might look at employees’ health and wellbeing, for example to prevent illness and improve productivity, but it must understand its focus.

“It’s important to have a very clear structure, focus and objectives, and [employers] can measure those objectives as they go through the programme,” she says. “How do they make it sustainable and long-term? Keep it fresh, adapt it to needs, and make sure they are always measuring against their initial objectives.”

One way of ensuring a health programme has a long-lasting effect on employees is through regular communication. Wayne Campbell, managing director of Healthy Performance, says communication such as a monthly newsletter containing details of national health events, a health tip of the month and food of the month, can be really engaging for employees and help embed a healthy way of thinking.

“The important thing about a healthy culture at work is making it a regular communication,” he says. “It doesn’t have to be something where [the employer] invests thousands of pounds. It could simply be, when it’s a health awareness week, for example, [using] some materials from a relevant charity. If it’s a regular thing, lots of employees will buy into it because it becomes the norm.”

National health events

Many employers use annual national health events to promote healthy initiatives, such as No Smoking Day in March, or National Heart Month in February. The HR index, published by business information firm Pearlfinders in July 2013, found that some employers invested in health and wellbeing during the first half of 2012 (pre-Olympics) and have since maintained that level of investment during 2013, whereas such investment has declined in some sectors [see box below].

Anthony Cooper, managing director of Pearlfinders, says: “We started tracking this in the build-up to the Olympics, and looked at what employers were doing with health and wellbeing, and if they were trying to ‘live the Games’ through the organisation. The positive thing is that the majority of sectors across the board are maintaining what they did last year.”

But can a health and wellbeing initiative establish a change in behaviour or attitude among employees? If, as Campbell suggests, an employer is communicating regularly about healthy living, and the opportunities are there, it may be easy for employees to form a habit of regular exercise or eating healthily, for example.

Dr Benjamin Gardner, lecturer in health psychology at the Health Behaviour Research Centre, University College London (UCL), says the workplace can be an ideal location to implement habit theory: a learned automatic response to a particular situation. “For a lot of people, unless they’re doing flexible working, they work in the same place, they go in at the same time each day, they sit in the same seat, and so much of their context is stable, it doesn’t change,” he says. “So it has the cues all in place; and as long as they’re interested, the workplace is a good place to get new habits up and running.”

But habits are easier to break than make, and a UCL study, How are habits formed: Modelling habit formation in the real world (P Lally, CHM van Jaarsveld, HWW Potts and J Wardle, published in the European Journal of Social Psychology, 2010), suggests that the 21-days-to-form-a-habit idea is a myth. The research found that, on average, automaticity, an automatic response, was reached after 66 days of repeating the same behaviour.

Change in behaviours

Many health initiatives can help to support and establish a change in employee behaviours over a number of weeks. Jill King, Europe, the Middle East and Africa (EMEA) director at the Global Corporate Challenge (GCC), says that although the GCC workplace wellness programme runs for 16 weeks each year, staff from participating organisations have access to support and additional initiatives for the entire year.

“It’s really about challenging people’s perceptions of getting active,” she says. “It’s not that we’re asking people to go to the gym for 16 weeks, because that’s not sustainable; we’re encouraging people to incorporate exercise into their everyday life.”

Establishing healthy habits is down to the individual, but initiatives such as the GCC can help lay the foundations, says King. “Even when the hype of the GCC and the excitement of being in a team has died down after those 16 weeks, simple changes, such as walking up the stairs instead of taking the escalator, those behaviours don’t disappear, they are the things that are ingrained and stay.”

Helping employees to change their habits to a healthier nature does not necessarily have to involve a long-term commitment from an employer, but it should take on a supportive role. Gardner says that although the UCL study suggests interventions need to be quite intensive and supportive of staff in the early stages, it should create a long-lasting change. “The intervention itself might only be short-term, but hopefully it will have long-term effects because you’ve tried to promote habits rather than just the change in behaviour,” he says.

Case study: Astellas

Pharmaceutical firm Astellas offers its staff a long-term programme to improve their activity and stress levels, weight and motivation. Since 2010, the organisation has taken part in the Global Corporate Challenge (GCC) wellbeing initiative, which measures participants’ daily activity levels through the number of steps they take, promoting a goal of 10,000 steps a day.

From 2010 to 2013, the number of Astellas employees that took part in the GCC has risen from 245 to 1,365, almost a third of its 4,500 workforce across Europe, the Middle East and Africa.

Rachel Hollier, HR programme manager at Astellas, says: “Employee wellness is a key part of our strategy. This is one of our key initiatives for that. It’s quite fun and a nicely collaborative and competitive way of encouraging employee wellness. It fits in well with the other things we do.”

The organisation’s UK headquarters gives staff the opportunity to join a bikes-for-work scheme, walking and running clubs, and take part in netball, football and tennis using its onsite sports pitches.

The statistics Astella receives from the GCC demonstrate the effect the programme has on employees’ health: pre-GCC, in 2012, 35% of its employees said they were inactive, taking fewer than 5,000 steps a day, but post-GCC, this figure went down to 9.4%. Highly active employees, who take more than 12,500 steps a day, made up only 7.1% of the workforce before the event, but afterwards they reached 50%.

Steve Hoblyn, senior director, employee engagement and HR effectiveness at Astellas, says: “Fundamentally, being a pharma company, our raison d’etre is to improve the lives of patients around the world, but from an HR perspective, we need to bring that internally and improve the lives of our employees. The health and wellness part of that is critical.”

Viewpoint: Dr Serena McCluskey

There is good empirical evidence that a biopsychosocial intervention, delivered in the workplace, is fundamental in tackling obstacles to work participation. The biopsychosocial approach emphasises the influence of individual beliefs, attitudes and behaviours, and work environment factors, for example organisational policies, practices and workplace culture, on health and wellbeing.

Specifically, it has been shown that for many common disorders, vocational rehabilitation comprising healthcare alone has little impact on occupational outcomes; significant input from the workplace and appropriate workplace accommodations is required, according to Vocational rehabilitation: what works, for whom, and when?, (G Waddell, AK Burton, NAS Kendall, published 2008).

While there is an assumption that such principles will apply to all workers, there is a dearth of evidence on outcomes later in the life course.

Supporting the continued work participation of older workers is crucial in light of the increasing age of the working population. The expectations being factored into pension reviews and legislation mean that people will continue working to older ages, but recent evidence by the Health and Safety Executive suggests that ill-health has a major impact on the work ability of older workers.

Older workers tend to have longer recovery times from illness and an increased risk of prolonged absence, and are disproportionately excluded from work via premature retirement or transition to low-skilled and low-paid jobs, resulting in their decreased wellbeing and increased social disadvantage, according to What about older and debilitated workers? Wellbeing and working life: towards an evidence-based policy agenda (A Weyman, published 2009) and Keeping folk in work longer (P Noone, published 2012).

It has been recognised that line managers are probably best placed to provide the necessary workplace accommodations, according to Dame Carol Black’s Review of the health of Britain’s working-age population (2008), but not well equipped to interpret and apply biopsychosocial principles. Educating and enabling line managers to adopt this approach may be key in reducing the costs incurred by the employer, society and the individual associated with prolonged sickness absence and premature retirement.

Dr Serena McCluskey is senior research fellow, Centre for Health and Social Care Research, University of Huddersfield

Investment in health and wellbeing: comparison between first half-year 2012 and first half-year 2013.

Source: Pearlfinders HR Index, July 2013